Healthcare Provider Details

I. General information

NPI: 1801007844
Provider Name (Legal Business Name): CINDY M ANDERSON PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/24/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1551 28TH AVE S
GRAND FORKS ND
58201-6782
US

IV. Provider business mailing address

4803 6TH AVE N
GRAND FORKS ND
58203-2605
US

V. Phone/Fax

Practice location:
  • Phone: 701-775-4251
  • Fax:
Mailing address:
  • Phone: 701-746-7104
  • Fax: 701-777-4096

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License NumberR23958
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: